Provider Demographics
NPI:1003778424
Name:STURDEVANT, KATELINN MICHELLE
Entity type:Individual
Prefix:
First Name:KATELINN
Middle Name:MICHELLE
Last Name:STURDEVANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATELINN
Other - Middle Name:
Other - Last Name:POWERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:408 E BOLTON ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31401-5920
Mailing Address - Country:US
Mailing Address - Phone:912-447-5530
Mailing Address - Fax:912-447-4613
Practice Address - Street 1:408 E BOLTON ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31401-5920
Practice Address - Country:US
Practice Address - Phone:912-447-5530
Practice Address - Fax:912-447-4613
Is Sole Proprietor?:No
Enumeration Date:2025-11-25
Last Update Date:2025-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health